Punthakee Xerxes, Palme Carsten E, Franklin Jason H, Zhang Irene, Freeman Jeremy L, Bedard Yvan C
Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Laryngoscope. 2005 Mar;115(3):433-6. doi: 10.1097/01.mlg.0000157854.47143.38.
OBJECTIVES/HYPOTHESIS: The objective was to evaluate the usefulness of standard suspect cytological features on fine-needle aspiration biopsy (FNAB) in predicting papillary thyroid carcinoma.
Retrospective chart review of consecutive fine-needle biopsies of the thyroid.
The study was a retrospective review of consecutive patients presenting with a diagnosis of suspected (group 1) or positive papillary thyroid carcinoma (group 2). The frequency of standard cytological features (i.e., papillary architecture, multinucleated giant cell, nuclear pseudo-inclusions, nuclear grooves, micronucleoli, powdery chromatin, and psammoma bodies) were recorded for each group. These were compared using chi test. Sensitivity and specificity for both individual and a combination of features were calculated for patients in group 1.
One hundred eight patients were eligible for the study (group 1, n = 57; group 2, n = 51). Fifty-one patients (89%) in group 1 and all patients in group 2 had a histopathological diagnosis of papillary thyroid carcinoma. Respectively, the most frequent features present on fine-needle aspiration biopsy in group 1 versus group 2 were nuclear grooves (79% vs. 88%), micronucleoli (74% vs. 86%), pseudo-inclusions (58% vs. 88%), and powdery chromatin (47% vs. 59%); P values for these features were P > .05, P > .05, P < .05, and P > .05, respectively. In group 1, the sensitivities of nuclear grooves and micronucleoli were 80% and 71%, respectively. The presence of psammoma bodies was associated with a specificity of 100%. A combination of nuclear grooves, micronucleoli, pseudo-inclusions, powdery chromatin, and multinucleated giant cells was 100% specific in detecting papillary thyroid carcinoma.
In choosing the most appropriate management of a finding suspect for papillary thyroid carcinoma on fine-needle aspiration biopsy, the surgeon must be aware of the diagnostic importance of certain cytopathological features. The presence of a combination of these factors may allow a more confident surgical approach.
目的/假设：目的是评估细针穿刺活检（FNAB）中标准可疑细胞学特征对预测甲状腺乳头状癌的有用性。
对连续的甲状腺细针活检进行回顾性病历审查。
该研究是对连续诊断为疑似（第1组）或甲状腺乳头状癌阳性（第2组）的患者进行的回顾性研究。记录每组标准细胞学特征（即乳头结构、多核巨细胞、核假包涵体、核沟、微核仁、粉末状染色质和砂粒体）的出现频率。使用卡方检验进行比较。计算第1组患者个体特征以及特征组合的敏感性和特异性。
108例患者符合研究条件（第1组，n = 57；第2组，n = 51）。第1组中的51例患者（89%）和第2组中的所有患者均有甲状腺乳头状癌的组织病理学诊断。第1组与第2组细针穿刺活检中出现的最常见特征分别为核沟（79%对88%）、微核仁（74%对86%）、假包涵体（58%对88%）和粉末状染色质（47%对59%）；这些特征的P值分别为P >.05、P >.05、P <.05和P >.05。在第1组中，核沟和微核仁的敏感性分别为80%和71%。砂粒体的存在特异性为100%。核沟、微核仁、假包涵体、粉末状染色质和多核巨细胞的组合在检测甲状腺乳头状癌方面特异性为100%。
在选择对细针穿刺活检中疑似甲状腺乳头状癌的发现进行最合适的处理时，外科医生必须了解某些细胞病理学特征的诊断重要性。这些因素的组合可能允许采取更有信心的手术方法。
